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Bribes, poorly trained medical staff and the lack of medical care for pregnant HIV-positive mothers are among the reasons for high rates of infant and maternal mortality in Uganda. NGOs want to see more government action.

According to the latest official figures from a 2006 health survey, 16 Ugandan women a day die in childbirth, and 76 newborns in every 1,000 do not reach the age of one.

"These unacceptable figures prove that basic maternal and infant care is not being provided, which is against the right to health recognized by international treaties ratified by Uganda, and against the constitution, which guarantees the rights of mothers," said Moses Mulumba, director of the Centre for Health, Human Rights and Development (CEHURD).

The leading direct causes of these deaths are haemorrhage (26 percent), sepsis (22 percent), obstructed labour (13 percent), unsafe abortion (8 percent) and hypertensive disorders in pregnancy (6 percent), according to the International HIV/AIDS Alliance in Uganda.

The petition also says Article 33 (3) and Article 34 (1) of the constitution are being violated. The first of these says: "The state shall protect women and their rights, taking into account their unique status and natural maternal functions in society," and the second: "Subject to laws enacted in their best interests, children shall have the right to know and be cared for by their parents or those entitled by law to bring them up."

Raising awareness

Proof that this petition has had some effect came on 20 July when the procurator-general requested an adjournment to prepare discussion documents. The next meeting on this is not expected before September.

"Even if the Constitutional Court rejects our petition, at least the issue has been brought to public attention. That is already a good thing," said Ben Twinomugisha, dean of the law faculty at Makerere University, Kampala. He was among those who signed the petition, with two families who lost relatives in childbirth.

The Health Ministry says it is doing everything it can to ensure the health of pregnant women and babies with the state's "meagre resources". It said that between 1990 and 2005, maternal mortality fell by 2.5 percent.

However, Asia Russel, international policy adviser for the US NGO Health Gap, which supports CEHURD, contests the reduction in mortality rates. Citing the 2006 health study, she says: "The methodology used and the sample sizes implemented in these three surveys do not allow for precise estimates of maternal mortality... Thus, it is impossible to say with confidence that maternal mortality has declined."

According to the International Monetary Fund, Zambia and Uganda have similar GDPs, but World Health Organisation figures show very different death rates for mothers in the two countries: 7.8 percent of all deaths of women of reproductive age in Zambia are related to childbirth, compared to 11.3 percent in Uganda. Health activists therefore claim the Ugandan government is not spending enough.

"We are fed up with the broken promises of the government - that they will provide us with the blood, ambulances, medicines and health workers," Mable Kukunda of the United Healthcare Organization (UNHCO) said. Annet Kyarimpa Ngabe, project coordinator for Reproductive Health Uganda, praised the eradication of tetanus among babies announced at the beginning of July by the authorities thanks to a vaccination drive among women of childbearing age.

However, Ngabe concedes that a lot more needs to be done to bring down maternal and infant mortality rates. "The government decided to set up health centres all around the country. But the staff haven't increased. In Mulago hospital [the biggest in Kampala], there are only five health workers in the maternity service instead of 20 before, to cover 60 births a day. So, the stress is high among the staff."

The stress, together with low pay (the equivalent of US$77 per month for a midwife) sometimes leads to corruption in public hospitals. "It is not unusual for doctors to ask for $150 from expectant mothers for special care," said Nile FM radio journalist Bakohg Swaleh.

"The government promised to allocate 15 percent of the budget to health. But so far, it has never been more than 11 percent. For instance, 2,000 more trained midwives are needed in Uganda," said Trevor Oresty Biransesha, a newborn specialist with NGO Save the Children. Pregnant women in rural districts are particularly vulnerable to this lack of resources.

Pregnant and HIV-positive

The situation is even more critical for pregnant women who are HIV-positive. At Mulago hospital, these future mothers are confined in a separate area marked with a large "plus" sign. Midwives do not seem keen to treat them.

"In order to give birth in public hospitals, the women should come with their birthing kits - gloves, blood bags, scissors, cotton wool, etc., which cost about $20. If women come without the kit, the midwives don't take care of them very well, and not at all if they are HIV-positive," said Marion Natukunda, a project officer with Mama's Club, which helps pregnant women with HIV.

Many women therefore refuse to give birth in public hospitals and are left with two choices: expensive private hospitals ($192) or traditional births ($11.50), chosen by 52 percent of pregnant women.

"In these cases the women who help to deliver use local leaves. Nothing is cleaned; the risk of infection is very high. We try to train these women but I always advise pregnant women to deliver in public hospitals," said Natukunda.

In northern districts affected by war, health services are negligible. There are few available medicines or staff. "We have very few health workers; most health centres lack ambulances for referral," said Charles Okwera, a health official in Kilak County, Amuru District.

Patience Adong sits in front of her mud and wattle hut: "Someone has to explain to me why this had to happen." During her pregnancy she sought care at Gulu hospital but lost her baby shortly after birth when it bled to death. "What bothers me a lot is my child dying due to bleeding because the nurse didn't tie its umbilical cord, it's terrible," she said.

The hospital authorities refused to comment, saying the matter was under investigation. "This is a serious matter. We are doing our part to establish the cause of death," northern Uganda police chief Martin Amoru told IRIN.